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Offerni JCM, Ai Li E, Rasmussen A, Xie WY, Levine MA, Murkin J, McAlister VC, Luke PP, Sener A. A Prospective Study of the Effect of Gastroduodenal Artery Reconstruction on Duodenal Oxygenation and Enzyme Content After Pancreas Transplantation. World J Surg 2023; 47:2846-2856. [PMID: 37700108 PMCID: PMC10545614 DOI: 10.1007/s00268-023-07149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Whole pancreas transplantation provides durable glycemic control and can improve survival rate; however, it can carry an increased risk of surgical complications. One devastating complication is a duodenal leak at the site of enteroenteric anastomosis. The gastroduodenal artery (GDA) supplies blood to the donor duodenum and pancreas but is commonly ligated during procurement. Since we have not had expressive changes in pancreatic back table surgical techniques in the recent decades, we hypothesized whether back table GDA reconstruction, improving perfusion of the donor duodenum and head of the pancreas, could lead to fewer surgical complications in simultaneous pancreas-kidney (SPK) transplants. MATERIAL AND METHODS Between 2017 and 2021, we evaluated demographic information, postoperative complications, intraoperative donor duodenum, recipient bowel O2 tissue saturation, and patient morbidity through the Comprehensive Complication Index (CCI®). RESULTS A total of 26 patients were included: 13 underwent GDA reconstruction (GDA-R), and 13 had GDA ligation (GDA-L). There were no pancreatic leaks in the GR group compared to 38% (5/13) in the GDA-L group (p = 0.03913). Intraoperative tissue oxygen saturation was higher in the GDA-R group than in the GDA-L (95.18 vs.76.88%, p < 0,001). We observed an increase in transfusion rate in GDA-R (p < 0.05), which did not result in a higher rate of exploration (p = 0.38). CCI® patient morbidity was also significantly lower in the GDA-R group (s < 0.05). CONCLUSIONS This study identified improved intraoperative duodenal tissue oxygen saturation in the GDA-R group with an associated reduction in pancreatic leaks and CCI® morbidity risk. A larger prospective multicenter study comparing the two methods is warranted.
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Affiliation(s)
- Juliano C M Offerni
- Department of General Surgery, Division of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Erica Ai Li
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Andrew Rasmussen
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Wen Y Xie
- Division of Transplantation and Hepatobiliary Surgery, University of Florida, Gainesville, FL, USA
| | - Max A Levine
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - John Murkin
- Department of Anesthesia & Perioperative Medicine at Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Vivian C McAlister
- University of Western Ontario, London, ON, Canada
- Department of General Surgery, London Health Sciences Center, London, ON, Canada
| | - Patrick P Luke
- University of Western Ontario, London, ON, Canada
- Division of Urology, Schulich School of Medicine & Dentistry, London Health Sciences Center, LHSC University Hospital, Western University, C4208, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Alp Sener
- University of Western Ontario, London, ON, Canada.
- Division of Urology, Schulich School of Medicine & Dentistry, London Health Sciences Center, LHSC University Hospital, Western University, C4208, 339 Windermere Road, London, ON, N6A 5A5, Canada.
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Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype. URO 2022. [DOI: 10.3390/uro2040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.
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3
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Teterin YS, Dmitriev IV, Suleimanova SK, Yartsev PA, Pinchuk AV. Endoscopic intraluminal treatment of pancreatic fluid collections after pancreas transplantation. Khirurgiia (Mosk) 2022:19-23. [PMID: 35775841 DOI: 10.17116/hirurgia202207119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To improve the outcomes after pancreas transplantation complicated by pancreatitis using percutaneous drainage and endoscopic stenting of the main pancreatic duct. MATERIAL AND METHODS There were 64 transplantations of the pancreatoduodenal complex between January 1, 2012 and December 31, 2021 at the Sklifosovsky Research Institute for Emergency Care. In 11 (17.2%) cases, early postoperative period was complicated by acute pancreatitis and parapancreatic fluid accumulations. Of these, 7 patients underwent ultrasound-guided percutaneous drainage of focal destructions. This procedure was effective and did not require additional treatment. In 4 patients, debridement and drainage were ineffective and required additional endoscopic stenting of the main pancreatic duct. RESULTS All patients underwent percutaneous drainage of peripancreatic fluid collections and subsequent fistulography. All patients had inhomogeneous cavities with irregular shape and volume of 19.6±1.8 cm3. In 3 (75%) out of 4 patients, there was a passage of contrast agent into the main pancreatic duct of the graft and donor duodenal stump. We did not find contrast enhancement of ductal system in 1 (25%) patient since filling of the cavity with a contrast agent was not tight. Sensitivity of this method for detecting pancreatic ductal defects was 75%. Indications for stenting of the main pancreatic duct were established in 22.5±9.6 days after transplantation. Drainage and debridement were ineffective in 2 (50%) patients. In other 2 (50%) patients, peripancreatic fluid collections enlarged. All patients underwent endoscopic stenting of the main pancreatic duct. CONCLUSION Endoscopic stenting of the main pancreatic duct of the donor pancreas combined with percutaneous drainage of peripancreatic fluid accumulations is a highly effective and minimally invasive approach for fluid collections after transplantation of the pancreatoduodenal complex. This method also minimizes the incidence of postoperative complications. Thanks to this method, we avoided redo open surgeries in all cases.
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Affiliation(s)
- Yu S Teterin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I V Dmitriev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | | | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A V Pinchuk
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Gurram V, Gurung K, Rogers J, Farney AC, Orlando G, Jay C, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Doares W, Kaczmorski S, Sharda B, Gautreaux MD, Stratta RJ. Do pretransplant C-peptide levels predict outcomes following simultaneous pancreas-kidney transplantation? A matched case-control study. Clin Transplant 2021; 36:e14498. [PMID: 34599533 DOI: 10.1111/ctr.14498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
Following simultaneous pancreas-kidney transplantation (SPKT), survival outcomes are reported as equivalent in patients with detectable pretransplant C-peptide levels (Cp+) and a "type 2″ diabetes mellitus (DM) phenotype compared to type 1 (Cp negative [Cp-]) DM. We retrospectively compared 46 Cp+ patients pretransplant (≥2.0 ng/mL, mean 5.4 ng/mL) to 46 Cp- (level < 0.5 ng/mL) case controls matched for recipient age, gender, race, and transplant date. Early outcomes were comparable. Actual 5-year patient survival (91% versus 94%), kidney graft survival (69% versus 86%, p = .15), and pancreas graft survival (60% versus 86%, p = .03) rates were lower in Cp+ versus Cp- patients, respectively. The Cp+ group had more pancreas graft failures due to insulin resistance (13% Cp+ versus 0% Cp-, p = .026) or rejection (17% Cp+ versus 6.5% Cp-, p = .2). Post-transplant weight gain > 5 kg occurred in 72% of Cp+ versus 26% of Cp- patients (p = .0001). In patients with functioning grafts, mean one-year post-transplant HbA1c levels (5.0 Cp+ versus 5.2% Cp-) were comparable, whereas Cp levels were higher in Cp+ patients (5.0 Cp+ versus 2.6 ng/mL Cp-). In this matched case-control study, outcomes were inferior in Cp+ compared to Cp- patients following SPKT, with post-transplant weight gain, insulin resistance, and rejection as potential mitigating factors.
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Affiliation(s)
- Venkat Gurram
- Departments of General Surgery, (Section of Transplantation)
| | - Komal Gurung
- Departments of General Surgery, (Section of Transplantation)
| | - Jeffrey Rogers
- Departments of General Surgery, (Section of Transplantation)
| | - Alan C Farney
- Departments of General Surgery, (Section of Transplantation)
| | | | - Colleen Jay
- Departments of General Surgery, (Section of Transplantation)
| | | | | | | | | | | | - Berjesh Sharda
- Departments of General Surgery, (Section of Transplantation)
| | - Michael D Gautreaux
- Department of Pathology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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5
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Ling JEH, Polkinghorne KR, Kanellis J. Results from an International Survey of Donor and Recipient Eligibility for Solid Organ Pancreas Transplantation. Ann Transplant 2021; 26:e930787. [PMID: 34031355 PMCID: PMC8166651 DOI: 10.12659/aot.930787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Current solid organ pancreas transplantation protocols have differing donor criteria for donor pancreas acceptance and recipient eligibility criteria for transplant workup. We quantified this variation and compared current Australia and New Zealand (ANZ) solid pancreas transplant eligibility criteria with current international practice. Material/Methods A survey of donor and recipient eligibility criteria for solid pancreas transplantation was disseminated to 85 transplant units in 23 countries. Responses were grouped by regions (ANZ, North America, Eurotransplant, Europe, United Kingdom) and analyzed for significant differences between regions and for ANZ compared to all other regions. Results Responding UK pancreas transplant units reported the highest mean donor upper age limit (61 years old) and the highest mean donation after cardiac death donor (DCD) age limit (55 years old). All responding UK and USA units utilized DCD pancreas donors and accepted suitable type 2 diabetes (T2DM) recipients for pancreas transplantation; however, this was less common among responding European or Eurotransplant units. ANZ mean standard and DCD pancreas donor upper age limits (47 and 35 years old, respectively) were lower compared to all other regions (54 years old and 48 years old, respectively). Conclusions Pancreas donor age limits, DCD pancreas donor utilization, and transplanting T2DM recipients differ between responding pancreas transplant units. ANZ units have more conservative donor upper age limits compared to other responding units. Increased utilization of DCD pancreas donors and T2DM recipients while standardizing pancreas donor age limits might increase donor numbers and improve access to solid pancreas transplantation both locally and abroad.
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Affiliation(s)
- Jonathan E H Ling
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
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6
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Yadav K, Stern J, Cholyway R. Pseudocyst of Pancreas Transplant Allograft: A Case Report. Transplant Proc 2020; 52:2831-2834. [PMID: 32859403 DOI: 10.1016/j.transproceed.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pancreatic pseudocysts are rarely reported complications of pancreas transplant. CASE We present a case of a patient with simultaneous pancreas and kidney transplant with bladder exocrine drainage who developed reflux pancreatitis and symptomatic pancreatic pseudocyst as a result of neuropathic bladder, 15 years after the original transplant. He was initially managed with percutaneous aspiration and drainage along with Foley catheter placement to help with bladder emptying. But the pseudocyst recurred after drains and Foley were removed. Eventually, he underwent an enteric conversion of the pancreas allograft with resolution of his symptoms and the pseudocyst. CONCLUSIONS Enteric conversion should be considered in cases of bladder-drained pancreas transplants with recurrent reflux pancreatitis and/or pseudocyst formation.
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Affiliation(s)
- Kunal Yadav
- Division of Transplantation, Department of Surgery, University Hospitals, Cleveland, OH, United States.
| | - Jeffrey Stern
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Renee Cholyway
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
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7
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Gibbons A, Cinnirella M, Bayfield J, Watson CJE, Oniscu GC, Draper H, Tomson CRV, Ravanan R, Johnson RJ, Forsythe J, Dudley C, Metcalfe W, Bradley JA, Bradley C. Changes in quality of life, health status and other patient‐reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK‐wide programme. Transpl Int 2020; 33:1230-1243. [DOI: 10.1111/tri.13677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/10/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Gibbons
- Health Psychology Research Unit Royal Holloway University of London London UK
- Department of Psychology University of Winchester Winchester UK
| | - Marco Cinnirella
- Psychology Department Royal Holloway University of London London UK
| | - Janet Bayfield
- Health Psychology Research Unit Royal Holloway University of London London UK
| | - Christopher J. E. Watson
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Gabriel C. Oniscu
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - Heather Draper
- Health Sciences Warwick Medical School University of Warwick Coventry UK
| | | | - Rommel Ravanan
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | | | - John Forsythe
- Transplant Unit Royal Infirmary of Edinburgh Edinburgh UK
- Organ Donation and Transplantation NHS Blood and Transplant Bristol UK
| | - Chris Dudley
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | - Wendy Metcalfe
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - J. Andrew Bradley
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Clare Bradley
- Health Psychology Research Unit Royal Holloway University of London London UK
- Health Psychology Research Ltd Egham UK
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8
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Mittal S, Smilevska R, Franklin R, Hammer C, Knight S, Vrakas G, Reddy S, Gilbert J, Quiroga I, Sharples E, Ploeg R, Friend P, Sinha S. An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study. Transpl Int 2020; 33:529-535. [DOI: 10.1111/tri.13575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/02/2020] [Accepted: 01/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Shruti Mittal
- Oxford Transplant Centre Oxford UK
- University of Oxford Oxford UK
- Oxford Biomedical Research Centre Oxford UK
| | | | - Rachel Franklin
- Oxford Transplant Centre Oxford UK
- Oxford Centre for Diabetes Metabolism and Endocrinology Oxford UK
| | | | | | | | | | | | | | | | - Rutger Ploeg
- Oxford Transplant Centre Oxford UK
- University of Oxford Oxford UK
- Oxford Biomedical Research Centre Oxford UK
| | - Peter Friend
- Oxford Transplant Centre Oxford UK
- University of Oxford Oxford UK
- Oxford Biomedical Research Centre Oxford UK
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9
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Mensink JW, de Vries KM, Huurman VAL, Pol RA, Alwayn IPJ, Braat AE. Risk analysis of extended pancreas donor selection criteria. Pancreatology 2019; 19:994-999. [PMID: 31495709 DOI: 10.1016/j.pan.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/04/2019] [Accepted: 08/25/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The success of pancreas transplantation, in combination with a stable number of available allografts has resulted in an increasing waiting list. This study investigated donor potential by expanding age and Body Mass Index (BMI) criteria. METHODS All reported donors in the Netherlands between 2013 and 2017 were analysed. Risk assessment of extended criteria donors was done by in-depth analysis of donor reports and calculation of the Pancreas Donor Risk Index (PDRI). The PDRI of these extended criteria donors was compared to standard criteria donors to evaluate the increased risk on graft failure. RESULTS A total of 1273 donors were reported. Of these donors, 405 donors were reported as pancreas donor, of which 93 (23%) pancreata were transplanted. Extending age criterion with 5 years could result in additional 40 Donation after Brain Death donors and 37 Donation after Circulatory Death donors reported. In 24 (31%) extended age criteria donors the PDRI was below the upper limit of currently transplanted pancreata. Extending BMI criteria to 35 kg/m2 could result in an additional 19 (6%) donors reported. CONCLUSIONS Extending BMI criteria could result in a slight increase of reported donors. Extending age criteria increased significantly the number of reported donors. In 24 (31%) of the older donors the PDRI showed a reduced risk compared to currently transplanted pancreata. This study suggest that, if other risk factors are absent, pancreata of extended age and/or BMI criteria donors should be considered for transplantation.
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Affiliation(s)
- Jacobus W Mensink
- Department of Transplant Surgery, LUMC, Leiden University, the Netherlands; Dutch Transplant Foundation, Leiden, the Netherlands.
| | | | | | - Robert A Pol
- Department of Transplant Surgery, UMCG, Groningen University, the Netherlands
| | - Ian P J Alwayn
- Department of Transplant Surgery, LUMC, Leiden University, the Netherlands
| | - Andries E Braat
- Department of Transplant Surgery, LUMC, Leiden University, the Netherlands
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10
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Liao WW, Ling XC, Zhang C, Liu FR, Zhu XF, He XS, Hu AB. Novel surgical technique and efficacy analysis of donor pancreas preparation without vascular reconstruction in pancreas transplantation. J Int Med Res 2019; 47:6182-6191. [PMID: 31500486 PMCID: PMC7045680 DOI: 10.1177/0300060519870894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas transplantation. We modified the vascular preparation procedure for the donor pancreas (i.e., no vascular reconstruction was performed) based on experiences in our department and in other domestic and international transplantation centers. Methods Twelve donor pancreas preparations without vascular reconstruction were performed. The patch (Carrel patch), celiac trunk, and superior mesenteric artery were preserved as arterial inflow channels for the donor pancreas. The common hepatic artery and the gastroduodenal artery were transected at a site 0.5 cm away from the bifurcation. The bifurcated portion was preserved for the donor liver. The stumps of the gastroduodenal artery and common hepatic artery were then ligated. The portal vein was transected in the middle of the hepatoduodenal ligament during separation of the liver and pancreas. The partial portal vein preserved with the pancreas was used as the outflow channel of the donor pancreas. Results The transplanted pancreas functioned well in the recipients, and no vascular complications were reported. Conclusion The overall efficacy of pancreas transplantation without vascular reconstruction has been improved.
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Affiliation(s)
- Wen-Wei Liao
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Xiang-Chao Ling
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Cheng Zhang
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Fu-Rong Liu
- Cardiac Surgery Itensive Care Unit of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Feng Zhu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Xiao-Shun He
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - An-Bin Hu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
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11
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Abstract
PURPOSE OF REVIEW Pancreas transplantation in type 2 diabetes mellitus (T2DM) candidates remains disproportionately lower than in type 1 diabetes mellitus (T1DM); however, outcomes in carefully selected patients mirrors that of T1DM. Despite the 2014 United Network for Organ Sharing (UNOS) eligibility criteria for simultaneous pancreas/kidney transplant (SPK) transplantation in T2DM patients, an expected increase in the number of transplants was not observed. RECENT FINDINGS In an updated International Pancreas and Transplant Registry (IPTR) analysis, 1514 primary deceased donor pancreas transplants were performed in T2DM recipients [1995-2015, SPK 88%, pancreas after kidney (PAK) 9%, pancreas transplant alone (PTA) 3%]. In contrast to the declining number of SPK transplants for T1DM, the number of primary SPK transplants in T2DM patients is increasing over time in the USA. Improvement over time was noted for T2DM SPK patient and graft survival, and the rate of technical failures decreased, paralleling similar overall trends for pancreas transplants in general. Long-term follow-up data of pancreas outcomes in C-peptide positive vs. negative demonstrate noninferior outcomes. BMI does not appear to impact outcomes in carefully selected T2DM candidates. SUMMARY The current UNOS regulations that currently limit access of T2DM to pancreas transplantation based on strict BMI criteria and C-peptide levels need to be liberated.
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12
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Fang Q, Zhai M, Wu S, Hu X, Hua Z, Sun H, Guo J, Zhang W, Wang Z. Adipocyte-derived stem cell-based gene therapy upon adipogenic differentiation on microcarriers attenuates type 1 diabetes in mice. Stem Cell Res Ther 2019; 10:36. [PMID: 30670068 PMCID: PMC6341531 DOI: 10.1186/s13287-019-1135-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Insulin replenishment is critical for patients with type 1 diabetes; however, current treatments such as pancreatic islet transplantation and insulin injection are not ideal. In addition to stem cell or gene therapy alone, stem cell combined with gene therapy may provide a new route for insulin replenishment, which could avoid an autoimmune reaction against differentiated β cells or systematic viral vector injection. METHODS In this study, human adipocyte-derived stem cells (ADSCs) were transducted with lentiviral vectors expressing a furin-cleavable insulin gene. The expression levels of insulin were measured before and after adipogenic differentiation in the presence or absence of an adipocyte-specific promoter AP2. In vitro proliferation and in vivo survival of cells were examined on cytodex and cytopore microcarriers. The effect of ADSC-based gene therapy upon adipogenic differentiation on microcarriers was evaluated in the streptozotocin-induced type 1 diabetic mouse model. RESULTS We found that differentiation of ADSCs into adipocytes increased insulin expression under the EF1 promoter, while adipocyte-specific AP2 promoter further increased insulin expression upon differentiation. The microcarriers supported cell attachment and proliferation during in vitro culture and facilitate cell survival after transplantation. Functional cells on the cytopore 1 microcarrier formed tissue-like structures and alleviated hyperglycemia in the type 1 diabetic mice after subcutaneous injection. CONCLUSIONS Our results indicated that differentiation of ADSC and tissue-specific promotors may enhance the expression of therapeutic genes. The use of microcarriers may facilitate cell survival after transplantation and hold potential for long-term cell therapy.
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Affiliation(s)
- Qing Fang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Min Zhai
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Shan Wu
- College of Chemical and Pharmaceutical Engineering, Hebei University of Science and Technology, Shijiazhuang, 050018, People's Republic of China.,Research Center for Translational Medicine, Cancer Stem Cell Institute, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Xiaogen Hu
- Department of Plastic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Zhan Hua
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Huizhuo Sun
- Beijing University of Chinese Medicine, Beijing, 100029, People's Republic of China.,The 2nd Department of Pulmonary Disease in TCM, The Key Unit of SATCM Pneumonopathy Chronic Cough and Dyspnea, Beijing Key Laboratory of Prevention and Treatment of Allergic Diseases with TCM (No. BZ0321), Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People's Republic of China
| | - Jing Guo
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Wenjian Zhang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Zai Wang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
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13
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Development and validation of a prognostic model for kidney function 1 year after combined pancreas and kidney transplantation using pre-transplant donor and recipient variables. Langenbecks Arch Surg 2018; 403:837-849. [PMID: 30338375 PMCID: PMC6244698 DOI: 10.1007/s00423-018-1712-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/17/2018] [Indexed: 01/20/2023]
Abstract
Purpose The widening gap between demand and supply of organs for transplantation provides extraordinary challenges for ethical donor organ allocation rules. The transplant community is forced to define favorable recipient/donor combinations for simultaneous kidney-pancreas transplantation. The aim of this study is the development of a prognostic model for the prediction of kidney function 1 year after simultaneous pancreas and kidney transplantation using pre-transplant donor and recipient variables with subsequent internal and external validation. Methods Included were patients with end-stage renal failure due to diabetic nephropathy. Multivariable logistic regression modeling was applied for prognostic model design with retrospective data from Hannover Medical School, Germany (01.01.2000–31.12.2011) followed by prospective internal validation (01 Jan. 2012–31 Dec. 2015). Retrospective data from another German transplant center in Kiel was retrieved for external model validation via the initially derived logit link function. Results The developed prognostic model is able to predict kidney graft function 1 year after transplantation ≥ KDIGO stage III with high areas under the receiver operating characteristic curve in the development cohort (0.943) as well as the internal (0.807) and external validation cohorts (0.784). Conclusion The proposed validated model is a valuable tool to optimize present allocation rules with the goal to prevent transplant futility. It might be used to support donor organ acceptance decisions for individual recipients. Electronic supplementary material The online version of this article (10.1007/s00423-018-1712-z) contains supplementary material, which is available to authorized users.
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He Y, Zhang D, Zeng Y, Ma J, Wang J, Guo H, Zhang J, Wang M, Zhang W, Gong N. Bone Marrow-Derived Mesenchymal Stem Cells Protect Islet Grafts Against Endoplasmic Reticulum Stress-Induced Apoptosis During the Early Stage After Transplantation. Stem Cells 2018; 36:1045-1061. [PMID: 29569832 DOI: 10.1002/stem.2823] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 12/16/2022]
Abstract
Early loss of grafted islets is the main obstacle to achieve favorable outcomes of islet transplantation. Mesenchymal stem cells are known to have a protective effect; however, its mechanism remains unclear. We hypothesized that bone marrow-derived mesenchymal stem cells (BMSCs) can protect grafted islets against endoplasmic reticulum stress (ERS)-induced apoptosis. In syngeneic streptozocin-induced diabetic BALB/c mice, islet grafts decreased blood glucose levels; however, the effect was not fully functional from the immediate post-transplant phase. β-Cell apoptosis was proven on days 1 and 3 after transplantation. Ultra-structural evidence of ERS was observed along with increased expressions of marker protein BIP and apoptosis-related protein CHOP. In contrast, BMSC co-transplantation maintained glucose hemostasis, inhibited apoptosis and alleviated ERS. In ex vivo culture, BMSCs improved viability of islets and decreased apoptosis. Increased ERS were observed in cultured islets exposed to hypoxia, but not in the islets cocultured with BMSCs. Furthermore, cocultured BMSCs protected islets against ERS-induced apoptosis as well as improved their insulin secretion, and BMSCs alleviated ERS by improving Myc expression through both stromal cell-derived factor 1 signal and contact effect. In conclusion, BMSCs protected the grafted islets against ERS-induced apoptosis during the early stage after transplantation. This study opens a new arena for ERS-targeted therapy to improve outcomes of islet transplantation. Stem Cells 2018;36:1045-1061.
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Affiliation(s)
- Ying He
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Zhang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Zeng
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junlei Ma
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Guo
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji Zhang
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengqin Wang
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijie Zhang
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianqiao Gong
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and the Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sánchez-Hidalgo JM, Salamanca-Bustos JJ, Arjona-Sánchez Á, Campos-Hernández JP, Ruiz Rabelo J, Rodríguez-Benot A, Requena-Tapia MJ, Briceño-Delgado J. What Is the Influence of Both Risk Donor and Risk Receiver on Simultaneous Pancreas-Kidney Transplantation? Transplant Proc 2018; 50:664-668. [PMID: 29579883 DOI: 10.1016/j.transproceed.2017.09.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/21/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Some factors affect the pancreas of a marginal donor, and although their influence on graft survival has been determined, there is an increasing consensus to accept marginal organs in a controlled manner to increase the pool of organs. Certain factors related to the recipient have also been proposed as having negative influence on graft prognosis. The objective of this study was to analyze the influence of these factors on the results of our simultaneous pancreas-kidney (SPK) transplantation series. MATERIALS AND METHODS Retrospective analysis of 126 SPK transplants. Donors and recipients were stratified in an optimal group (<2 expanded donor criteria) and a risk group (≥2 criteria). A pancreatic graft survival analysis was performed using a Kaplan-Meier test and log-rank test. Prognostic variables on graft survival were studied by Cox regression. Postoperative complications (graded by Clavien classification) were compared by χ2 test or Fisher test. RESULTS Median survival of pancreas was 66 months, with no significant difference between groups (P > .05). Multivariate analysis showed risk factors to be donor age, cold ischemia time, donor body mass index, receipt body mass index, and receipt panel-reactive antibody. CONCLUSIONS In our series, the use of pancreatic grafts from donors with expanded criteria is safe and has increased the pool of grafts. Different variables, both donor and recipient, influence the survival of the pancreatic graft and should be taken into account in organ distribution systems.
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Affiliation(s)
| | | | - Á Arjona-Sánchez
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | | | - J Ruiz Rabelo
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - A Rodríguez-Benot
- Department of Nephrology, University Hospital Reina Sofia, Córdoba, Spain
| | - M J Requena-Tapia
- Department of Urology, University Hospital Reina Sofia, Córdoba, Spain
| | - J Briceño-Delgado
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
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Duff CE, Simmonds MJ. Genetic predictors of long-term graft function in kidney and pancreas transplant patients. Brief Funct Genomics 2017; 16:228-237. [PMID: 28110269 DOI: 10.1093/bfgp/elw039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Kidney and pancreas transplantation have helped transform the lives of people with end-stage renal failure and individuals with type 1 diabetes who have poor glycaemic control/severe secondary complications, respectively. Despite an improvement in immunosuppressive regimes, operative techniques and decreased initial rejection rates, there has been little improvement in long-term graft survival rates over the past decade. Whilst limited progress has been made in establishing clinical markers of graft function, several genetic markers of long-term graft function have been identified. These genetic markers have the potential to (i) assist in selecting marginal donor organs for transplantation, (ii) provide better understanding of the mechanisms behind graft loss enabling identification of new, or repurposing, current treatments to extend graft function and (iii) provide a window of opportunity to identify and treat individuals before graft failure has occurred. This review will discuss the different genetic variants screened for a role in predicting transplant longevity, examine their findings and limitations and introduce where the future of genetic research within the transplantation field lies.
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Gruessner AC, Laftavi MR, Pankewycz O, Gruessner RWG. Simultaneous Pancreas and Kidney Transplantation-Is It a Treatment Option for Patients With Type 2 Diabetes Mellitus? An Analysis of the International Pancreas Transplant Registry. Curr Diab Rep 2017; 17:44. [PMID: 28478590 DOI: 10.1007/s11892-017-0864-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Pancreas transplantation remains the best long-term treatment option to achieve euglycemia and freedom from insulin in patients with labile diabetes mellitus. It is an approved procedure for type 1 (T1DM), but it is still considered controversial for type 2 diabetes mellitus (T2DM). RECENT FINDINGS This study analyzed all primary deceased donor pancreas transplants in patients with T2DM reported to IPTR/UNOS between 1995 and 2015. Characteristics, outcomes, and risk factors over time were determined using univariate and multivariate methods. The focus was on simultaneous pancreas/kidney (SPK) transplants, the most common pancreas transplant category. Patient, pancreas, and kidney graft survival rates increased significantly over time and reached 95.8, 83.3, and 91.1%, respectively, at 3 years posttransplant for transplants performed between 2009 and 2015. SPK is a safe procedure with excellent pancreas and kidney graft outcome in patients with T2DM. The procedure restores euglycemia and freedom from insulin and dialysis. Based on our results, SPK should be offered to more uremic patients with labile T2DM.
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Affiliation(s)
- Angelika C Gruessner
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA.
| | - Mark R Laftavi
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - Oleh Pankewycz
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Rainer W G Gruessner
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
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Salamanca-Bustos JJ, Campos-Hernandez JP, Sánchez-Hidalgo JM, Arjona-Sánchez A, Sánchez-González A, Arenas-Bonilla AJ, Ruiz-Rabelo J, Carrasco-Valiente J, Ruiz-García J, Regueiro-López JC, Briceño-Delgado J, Requena-Tapia MJ. Validation of the Pancreatic Donor Risk Index in Simultaneous Pancreas-Kidney Transplantation Performed in Córdoba Hospital From 2000 to 2015. Transplant Proc 2017; 48:3037-3039. [PMID: 27932141 DOI: 10.1016/j.transproceed.2016.07.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Pancreatic Donor Risk Index (PDRI) was developed in 2010 in the United States to predict graft survival after pancreas transplantation, based on donor characteristics and logistical and technical conditions. The aim of the study was to validate the utility of PDRI as a pancreas allograft survival predictor in simultaneous pancreas-kidney transplantation (SPK) transplants performed in our hospital between 2000 and 2015. METHODS This retrospective analysis of 126 SPK transplants was performed by the same surgical team from the years 2000 to 2015. Donor variables that are integrated in the PDRI were calculated (age, sex, race, creatinine serum levels, body mass index, height, cold ischemia time, cause of death, type of pancreas transplant). Pancreatic graft survival at 1 and 5 years was calculated by use of the Kaplan-Meier test. Comparison of survival curves between PDRI risk quartiles was calculated by use of the log-rank test. Association between graft survival and variables integrating the PDRI was calculated by use of univariate Cox regression analysis. RESULTS Log-rank analysis found no statistically significant association between global graft survival and PDRI quartiles. Univariate Cox regression analysis showed a statistically significant association between graft survival and cold ischemia time (P < .05). CONCLUSIONS PDRI was not a useful tool to predict pancreatic graft outcomes in a Spanish reference population.
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Affiliation(s)
| | | | | | - A Arjona-Sánchez
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | | | - J Ruiz-Rabelo
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | - J Ruiz-García
- Department of Urology, University Hospital Reina Sofía, Córdoba, Spain
| | | | - J Briceño-Delgado
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - M J Requena-Tapia
- Department of Urology, University Hospital Reina Sofía, Córdoba, Spain
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Havrdova T, Boucek P, Saudek F, Voska L, Lodererova A, Üçeyler N, Vondrova H, Skibova J, Lipar K, Sommer C. Severe Epidermal Nerve Fiber Loss in Diabetic Neuropathy Is Not Reversed by Long-Term Normoglycemia After Simultaneous Pancreas and Kidney Transplantation. Am J Transplant 2016; 16:2196-201. [PMID: 26751140 DOI: 10.1111/ajt.13715] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/16/2015] [Accepted: 01/02/2016] [Indexed: 01/25/2023]
Abstract
Whether nerve fiber loss, a prominent feature of advanced diabetic neuropathy, can be reversed by reestablishment of normal glucose control remains questionable. We present 8-year follow-up data on epidermal nerve fiber (ENF) density and neurological function in patients with type 1 diabetes after simultaneous pancreas and kidney transplantation (SPK) with long-term normoglycemia. Distal thigh skin biopsies with ENF counts, vibration perception thresholds (VPTs), autonomic function testing (AFT) and electrophysiological examinations were performed at time of SPK and 2.5 and 8 years after SPK in 12 patients with type 1 diabetes. In comparison to controls, baseline ENF density, VPT and AFT results of patients indicated severe neuropathy. At follow-up, all SPK recipients were insulin independent with excellent glycemic control and kidney graft function; however, the severe ENF depletion present at baseline had not improved, with total ENF absence in 11 patients at 8-year follow-up. Similarly, no amelioration occurred in the VPT and AFT results. Numerical improvement was seen in some electrophysiological parameters; however, statistical significance was achieved only in median motor nerve conduction velocity. ENF loss and functional deficits in advanced diabetic peripheral neuropathy are rarely reversible, even by long-term normoglycemia, which underscores the importance of neuropathy prevention by early optimal glycemic control.
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Affiliation(s)
- T Havrdova
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - P Boucek
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - F Saudek
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - L Voska
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - A Lodererova
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - N Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - H Vondrova
- Department of Neurology, Thomayer Hospital, Prague, Czech Republic
| | - J Skibova
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - K Lipar
- Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - C Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
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Mittal S, Lee FJ, Bradbury L, Collett D, Reddy S, Sinha S, Sharples E, Ploeg RJ, Friend PJ, Vaidya A. Validation of the Pancreas Donor Risk Index for use in a UK population. Transpl Int 2016; 28:1028-33. [PMID: 25789920 DOI: 10.1111/tri.12563] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 01/22/2015] [Accepted: 03/10/2015] [Indexed: 01/07/2023]
Abstract
Pancreas graft failure rates remain substantial. The PDRI can be used at the time of organ offering, to predict one-year graft survival. This study aimed to validate the PDRI for a UK population. Data for 1021 pancreas transplants were retrieved from a national database for all pancreas transplants. Cases were categorized by PDRI quartile and compared for death-censored graft survival. Significant differences were observed between the UK and US cohorts. The PDRI accurately discriminated graft survival for SPK and was associated with a hazard ratio of 1.52 (P = 0.009) in this group. However, in the PTA and PAK groups, no association between PDRI quartile and graft survival was observed. This is the largest study to validate the PDRI in a European cohort and has shown for the first time that the PDRI can be used as a tool to predict graft survival in SPK transplantation, but not PTA or PAK transplantation.
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Affiliation(s)
- Shruti Mittal
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Fang Jann Lee
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK
| | | | | | - Srikanth Reddy
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK
| | - Sanjay Sinha
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK
| | - Edward Sharples
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK
| | - Rutger J Ploeg
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK
| | - Peter J Friend
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,NIHR Biomedical Research Centre, Oxford, UK
| | - Anil Vaidya
- Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK
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Mittal S, Choudhary P, Callaghan C, Hilton R, Drage M. First case of pancreas transplant alone in a patient with diabetes and HIV infection. Int J STD AIDS 2016; 27:1350-1353. [PMID: 27099169 DOI: 10.1177/0956462416645996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
Abstract
Chronic conditions have largely replaced opportunistic infections as the leading causes of mortality in human immunodeficiency virus (HIV) infection. Pancreas transplantation alone can be performed for people with difficult to manage diabetes associated with severe hypoglycaemic unawareness. For carefully selected patients, pancreas transplantation alone has the potential to dramatically improve quality and quantity of life. Historically, HIV was considered a contraindication to transplantation; however, today renal transplantation for people with end-stage kidney disease and HIV infection is increasingly common. We describe the use of a standard immunosuppression regimen in combination with effective antiretroviral control using a stable highly active antiretroviral therapy regimen with minimal interaction with immunosuppressants. We describe what is, to our knowledge, the first case of pancreas transplantation alone performed for this particularly challenging group, resulting in complete resolution of hypoglycaemic symptoms. We suggest that this group of patients should receive optimal diabetes management, including access to transplantation where appropriate, and demonstrate that pancreas transplantation alone is feasible for people with HIV infection.
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Affiliation(s)
- Shruti Mittal
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
| | - Pratik Choudhary
- Department of Diabetic Medicine, Kings College Hospital, London, UK
| | - Chris Callaghan
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
| | - Rachel Hilton
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
| | - Martin Drage
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
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Meirelles Júnior RF, Salvalaggio P, Pacheco-Silva A. Pancreas transplantation: review. EINSTEIN-SAO PAULO 2015; 13:305-9. [PMID: 26154551 PMCID: PMC4943828 DOI: 10.1590/s1679-45082015rw3163] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 02/08/2015] [Indexed: 12/20/2022] Open
Abstract
Vascularized pancreas transplantation is the only treatment that establishes normal glucose levels and normalizes glycosylated hemoglobin levels in type 1 diabetic patients. The first vascularized pancreas transplant was performed by William Kelly and Richard Lillehei, to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison Teixeira performed the first isolated segmental pancreas transplant in 1968. Until the 1980s, pancreas transplants were restricted to a few centers of the United States and Europe. The introduction of tacrolimus and mycophenolate mofetil in 1994, led to a significant outcome improvement and consequently, an increase in pancreas transplants in several countries. According to the International Pancreas Transplant Registry, until December 31st, 2010, more than 35 thousand pancreas transplants had been performed. The one-year survival of patients and pancreatic grafts exceeds 95 and 83%, respectively. The better survival of pancreatic (86%) and renal (93%) grafts in the first year after transplantation is in the simultaneous pancreas-kidney transplant group of patients. Immunological loss in the first year after transplant for simultaneous pancreas-kidney, pancreas after kidney, and pancreas alone are 1.8, 3.7, and 6%, respectively. Pancreas transplant has 10 to 20% surgical complications requiring laparotomy. Besides enhancing quality of life, pancreatic transplant increases survival of uremic diabetic patient as compared to uremic diabetic patients on dialysis or with kidney transplantation alone.
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Hamilton A, Mittal S, Barnardo MCNM, Fuggle SV, Friend P, Gough SCL, Simmonds MJ. Genetic variation in caveolin-1 correlates with long-term pancreas transplant function. Am J Transplant 2015; 15:1392-9. [PMID: 25787790 DOI: 10.1111/ajt.13104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 01/25/2023]
Abstract
Pancreas transplantation is a successful treatment for a selected group of people with type 1 diabetes. Continued insulin production can decrease over time and identifying predictors of long-term graft function is key to improving survival. The aim of this study was to screen subjects for variation in the Caveolin-1 gene (Cav1), previously shown to correlate with long-term kidney transplant function. We genotyped 435 pancreas transplant donors and 431 recipients who had undergone pancreas transplantation at the Oxford Transplant Centre, UK, for all known common variation in Cav1. Death-censored cumulative events were analyzed using Kaplan-Meier and Cox regression. Unlike kidney transplantation, the rs4730751 variant in our pancreas donors or transplant recipients did not correlate with long-term graft function (p = 0.331-0.905). Presence of rs3801995 TT genotype (p = 0.009) and rs9920 CC/CT genotype (p = 0.010) in our donors did however correlate with reduced long-term graft survival. Multivariate Cox regression (adjusted for donor and recipient transplant factors) confirmed the association of rs3801995 (p = 0.009, HR = 1.83;[95% CI = 1.16-2.89]) and rs9920 (p = 0.037, HR = 1.63; [95% CI = 1.03-2.73]) with long-term graft function. This is the first study to provide evidence that donor Cav1 genotype correlates with long-term pancreas graft function. Screening Cav1 in other datasets is required to confirm these pilot results.
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Affiliation(s)
- A Hamilton
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
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Mittal S, Franklin RH, Policola C, Sharples E, Friend PJ, Gough SCL. Early postoperative continuous glucose monitoring in pancreas transplant recipients. Transpl Int 2015; 28:604-9. [DOI: 10.1111/tri.12541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/07/2015] [Accepted: 02/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Shruti Mittal
- Oxford Transplant Centre; Oxford University Hospital NHS Trust; Oxford UK
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - Rachel H. Franklin
- Oxford Centre for Diabetes, Endocrinology and Diabetes; University of Oxford; Oxford UK
| | - Caterina Policola
- Dipartimento di Endocrinologia e Malattie del Metabolismo; Università Cattolica Del Sacro Cuore; Rome Italy
| | - Edward Sharples
- Oxford Transplant Centre; Oxford University Hospital NHS Trust; Oxford UK
| | - Peter J. Friend
- Oxford Transplant Centre; Oxford University Hospital NHS Trust; Oxford UK
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
- NIHR Biomedical Research Centre; Oxford UK
| | - Stephen C. L. Gough
- Oxford Centre for Diabetes, Endocrinology and Diabetes; University of Oxford; Oxford UK
- NIHR Biomedical Research Centre; Oxford UK
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